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Leeds KONP NHS News Digest August 17
Cuts bite
p2 IVF cut back in 13 areas of England to save money, new data shows Guardian 6.8.17
3 Cash-strapped councils told to meet ‘undeliverable’ bed-blocking targets or have social care funding
slashed The Independent Online 22.8.17
4 NHS England’s plan to reduce wasteful and ineffective drug prescriptions Azeem Majeed Professor of
primary care, Imperial College London, in BMJ 1.8.17
5 Legal case argues cuts to personal budget breaches Care Act 2014 Extracts from a Canary article 17.8.17
6 Rise in life expectancy has stalled since 2010, research shows by Denis Campbell, Guardian 18.7 on Marmott
Staff shortages
7 NHS maternity wards in England forced to close 382 times last year Guardian 8.8.17
8 Almost all large NHS trusts fail to have correct number of nurses Paul Gallagher in Indi News 13.8.17
Is it possible to recruit 21,000 extra staff for mental health services? Gareth Iacobucci in the BMJ 15.8.17
Privatisations and sell offs
9 Stephen Hawking blames Tory politicians for damaging NHS, Guardian 18.8 and 10 Jeremy Hunt can attack me all he wants – but he is wrong to say the NHS is working Hawking 25.8.17
11 Audit Office asked to investigate NHS Professionals sale on Keep Our NHS Public website 21.8.17 12 Response from Jonathan Ashworth, Shadow Minister for Health, to a constituent’s concern re the sale
and request for him to sign EDM 152- NHS Professionals 25.8
Tory government quietly doubles number of NHS properties it is selling off Rob Merrick, Independent 8.17
13 NHS will be selling surplus land for at least 10 years – but will it make a difference? Paul Gallagher,
Independent Daily Briefing 13.8 2017 – note ref to Leeds Addiction Unit and Doncaster and Bassetlaw Hospitals!
Accountable Care Organisations / Systems
14 NHS England reveals first national contract for ACOs Greg Dropkin ‘s report of a Health Service Journal
report by Rebecca Thomas 7.8.17 15 Brief comment on ACO contracts from Peter Broderick ( co- designer of the NHS Bill) 24.8.17
Local News 15 NHS trust sent cancer patient adverts for private clinic Denis Campbell Health policy editor, Guardian 5.8.17
and extract from Leeds NHS hospital trust sent cancer patients private care ads in Yorkshire Eve. Post 6.8 16 plus response from Dr. John Puntis in letter to the YEP 14.8.17
Leeds hospital bosses consider ‘buy now, pay later’ PFI contract Yorkshire Evening Post 13.8.17 plus
17 response from Dr. John Puntis in Letter to YEP published 15.8
18 Fears for jobs in York Hospital shake up by Alex Ross in York Press 11.7.17
York trust pulls out of Ryedale community health services as CCG opts for to ‘commercial procurement
Victoria Prest in York Press 31.7.17
Cuts bite
IVF cut back in 13 areas of England to save money, new data shows Guardian 6.8.17 https://www.theguardian.com/society/2017/aug/06/ivf-cut-back-in-13-areas-of-england-in-bid-to-save-money-new-data-shows
Fertility Network UK figures reveal many areas have stopped offering three cycles of IVF to couples trying to conceive, against government guidelines. Thirteen areas of England have restricted or completely halted IVF treatment since the start of the year for women struggling to conceive, with a further eight consulting on taking similar steps.
Data provided by Fertility Network UK showed the scale of local NHS cutbacks in a bid to save money, defying national guidelines and prompting warnings of a postcode lottery for couples trying to have children.
The figures also show that over the past four years the number of clinical commissioning groups (CCGs) in England offering three full cycles of IVF has fallen by 46%, from 50 in 2013 to 27 this year.
NHS group Nice recommends that women aged under 40 should be offered three cycles if they have been trying to conceive for two years, which means cost-cutting CCGs are defying advice set out by the government and the NHS’s own advisers. Prof Simon Fishel, who was part of a team that pioneered IVF in the UK, said his main concern was the inequality of cuts. Fishel said: “What is the point of having Nice guidelines if they are not adhered to?” He added: “If the country decides it will not fund IVF then fine, that is a decision that affects everyone … but what I cannot abide is the local variation for something like this, which doesn’t reflect local populations.” “You have to treat citizens equally and this is a deliberate inequality and obfuscation and allows some areas to say they are offering IVF but when it comes down to the detail, only a tiny fraction of those who need it have access to it.”
NHS providers in Bristol, North Somerset and South Gloucestershire are consulting on restricting fertility treatment in future to women aged 30-35. This would make them the first in the UK to limit services to such a narrow age range.
In Cambridgeshire and Peterborough, a petition signed by 2,088 people is calling for the local CCG to scrap plans to cut funding for IVF treatments.
Dr Gary Howsam, chair of Cambridgeshire and Peterborough CCG, said: “We are now in the difficult position where we have to evaluate every service we commission.” “[We have] been consulting on a proposal to stop routinely commissioning any specialist fertility services other than for two specified exceptions. The exceptions are fertility preservation for patients who have a condition requiring treatment that has a significant likelihood of making them infertile, and sperm washing for men who have a chronic viral infection.”
In London, Croydon became the first London borough to stop funding for IVF earlier this year. The decision was made to help save £836,000 annually. Others areas that have cut back from three cycles to one cover Swindon, plus most of Cheshire.
.Areas of England that have cut, stopped or are consulting on reducing IVF treatment since the beginning of 2017
CCG
IVF treatment status
Wyre Forest
Has decided to reduce the number of cycles they fund from two to one
Wirral
Cut from three treatment cycles to two
West Essex
Consulting on reducing or totally removing funding for IVF except on ‘exceptional’ grounds
West Cheshire
Cut from three treatment cycles to one
Vale Royal
Cut from three treatment cycles to one
Families hoping to conceive are increasingly having to pay privately.
Susan Seenan, the chief executive of Fertility Network UK, said infertility can have a serious and lasting impact and denying people help is “a short-sighted and false economy”.
Seenan said: “The situation in England is in stark contrast to that in Scotland, where all those eligible receive three full cycles of NHS-funded treatment, including couples where one partner has no child. England pioneered IVF approaching 40 years ago, but that achievement literally means nothing if only those who can afford to pay for IVF benefit from it.”
Couples in Wales are eligible for two full cycles of treatment, but in Northern Ireland those hoping to conceive are only eligible for one part-cycle.
Geeta Nargund, a professor and founder of Create Fertility, said she was saddened by the numbers, calling on the health secretary, Jeremy Hunt, to look into it to ensure equal access.
A health department spokesperson said: “The NHS should provide access to services, including IVF, for all patients who meet the criteria set out by independent experts at Nice.” A spokesperson for NHS England said that these were legally decisions for CCGs, “who are under an obligation to balance the various competing demands on the NHS locally while living within the budget parliament has allocated”.
Cash-strapped councils told to meet ‘undeliverable’ bed-blocking targets or have social care funding slashed The Independent Online 22.8.17
The Government has ordered councils to reduce the number of people remaining in hospital when they are fit to be discharged by as much as 70 per cent before winter, or see social care funding withdrawn from them in the Spring Budget next year .
In a letter seen by The Independent delivered to all councils responsible for delivering social care, the Department of Health warns that NHS England will hold them “to account” for their role in delivering targets before the winter, and “take action” if they fail to meet them. Council leaders warned that the threats from central Government leave them facing a “double whammy” of underfunding and prospective cuts to funds, which they said would see the elderly, vulnerable, and disabled suffer most.
Barbara Keeley, Labour’s Shadow Minister for Social Care, accused to Government of mounting an “overly simplistic and ill-judged” response to bed-blocking, and warned that the threats to councils were only likely to make current challenges in social care worse.
The rise in transfers of care – also known as bed-blocking – saw patients in England experience some 177,000 days worth of delays in April this year alone. A total of 55 per cent of these were down to issues in the NHS internally, while 38 per cent were attributable to social care, according to NHS England.
Analysis by the County Councils Network (CCN), which represents county councils in England, revealed that rural councils, all mostly Conservative controlled and representing more than 26 million people, were given the hardest targets, averaging at 43 per cent – double the target of London. Herefordshire County Council has a target of a 69 per cent reduction, while Suffolk has a target of 67 per cent, the analysis shows. The CCN has written to Jeremy Hunt to urge the Department of Health to urgently reconsider the proposals, that county council leaders have called “undeliverable” and “arbitrary” tasks.
The letter from the Department of Health stated that through the Better Care Fund, Clinical Commissioning Groups were “agreeing targets for reducing delays” and that NHS England would “hold them to account for their role in delivering these,” adding: “NHS England will performance manage Clinical Commissioning Groups against the Better Care Fund metrics and take action where they do not meet them.” It continued: “In November we will take stock of progress to date and will consider a review of 2018/19 allocations of the social care funding provided at Spring Budget 2017 for areas that remain poorly performing at the end of November.”
Council leaders are viewing this as a threat to their social care budgets next year. A spokesperson for the Department of Health confirmed that a review of 2018/19 allocations of the social care funding provided in the Spring Budget 2017 for areas that are “poorly performing” would take place, but urged that the funding would “remain with local government, to be used for adult social care”.
Chairman of the Local Government Association’s Community Wellbeing Board, Councillor Izzi Seccombe, said the targets were “counter-productive” and “ignored local need”..
Responding to the concerns, Shadow Minister for Social Care Ms Keeley accused the Tories of mounting an “overly simplistic and ill-judged” response to the problem, saying: “Threatening councils with reductions in funding if they miss arbitrary targets for reducing delayed transfers is likely to make the crisis in social care worse . “The rising number of people stuck in hospital and unable to get home is symptomatic of the mounting crisis in social care more generally. Tory Ministers are now pitting councils and the NHS against each other, just when we need them to be working together. “The problem of delayed discharges will only be solved if the Government tackles the bigger problem of the mounting funding crisis in social care.”
It comes amid concerns of an impending crisis in the care sector, as residential homes struggle to cope with steadily rising costs and cuts to funding while being faced with a rapdily ageing population that is projected to see the number of elderly people requiring a place almost double within the next 20 years.
One in six care homes in the UK are showing signs they are at risk of failure, with the percentage of nursing homes displaying the hallmarks of financial distress having increased by about 5 per cent compared with the previous year as businesses in the sector are pushed “back to the brink”, according to a report by accountancy firm Moore Stephens last week.
A report by charity Age UK last month meanwhile revealed that thousands of care home residents were being wrongly charged fees of up to £100 a week, as one in four pensioners who are entitled to free care were being told to contribute towards their care costs to subsidise gaps in care home funding from councils.
NHS England’s plan to reduce wasteful and ineffective drug prescriptions
Azeem Majeed professor of primary care Imperial College London, UK in BMJ 1.8.17
The NHS in England must make around £22bn (€25bn; $29bn) of efficiency savings by 2020. Prescribing costs in primary care, currently around £9.2bn annually, are a key component of the NHS budget in England. Inevitably, the NHS has begun to look at the drugs prescribed by general practitioners to identify areas in which savings could be made, ideally without compromising patient care or worsening health inequalities. This process was initially led by clinical commissioning groups (CCGs), focusing on drugs that are either of limited clinical value or which patients can buy from retailers without a prescription (“over the counter” drugs).
Flawed approach
However, this locally based approach is flawed.2 Firstly, CCGs have no legal power to limit the prescribing of drugs by GPs. As CCG policies on restricting prescriptions are not backed by statutory guidance, the inevitable result will be variation between GPs in the use of the drugs that CCGs are proposing to restrict—thereby leading to “postcode prescribing.”
It also raises legal issues—if there is a complaint about a refusal to issue a prescription it will be the GP who will have to defend any complaint made by the patient, and not the CCG. Each CCG carrying out its own evidence review and public and professional consultation, and developing its own implementation policy, also results in duplication of effort and is a poor use of NHS resources.
NHS England has now launched its own consultation process to identify areas where “wasteful or ineffective” prescribing can be reduced. However, although a national process is better than local processes, NHS England has not stopped CCGs from continuing to roll out their own restrictions on prescribing—even though some of these will inevitably conflict with the guidance produced by NHS England when it completes its consultation process.
In its consultation document, NHS England proposes restrictions on prescribing for a range of drugs. Stopping prescribing in some areas—such as homeopathy and herbal remedies—will not be controversial, but will not save much money either. Some other drugs that NHS England is proposing to restrict, such as liothyronine, have limited evidence for their benefits, but some patients do find them useful, and patients and some clinicians will express resistance to the proposed restrictions on their use.
The two most controversial areas will be around NHS prescriptions for gluten-free foods—for which there was a separate consultation and for drugs available over the counter. Gluten-free foods are essential for people with coeliac disease, and although they are now more widely available from retailers than in the past, many patients continue to receive NHS prescriptions and will resist strongly any restrictions. Regarding drugs available over the counter—for example, treatments for head lice or hay fever—many patients will be able to pay for these themselves. Some poorer patients will, however, struggle with the costs of buying such drugs.
NHS England is to be congratulated for launching its public consultation and not just leaving decisions about eligibility for NHS treatment to individual CCGs. However, it needs to ensure that its recommendations are accepted by CCGs and that the restrictions on prescribing that some CCGs are trying to impose fall into line with national recommendations. NHS England also needs to make the necessary changes to the National General Practice Contract and to the NHS Drugs Tariff, to ensure that any prescribing restrictions it imposes have a firm legal basis.
If this is not done, it places GPs in the invidious position of being at clinical and legal risk if they adopt NHS England’s
prescribing guidance when this is finally published, at a time when they are already under considerable workload pressure.8
Adverse consequences
Restrictions on prescribing and the reduced availability of drug treatments on the NHS will have adverse consequences. For example, unintended effects are a risk, such as codeine based analgesics being used in place of simpler analgesics like paracetamol or ibuprofen if the use of the latter is restricted. We also need to ensure that prescribing restrictions do not affect patients with very serious conditions. For example, if restrictions are imposed on NHS prescriptions of laxatives because these are available to buy from retailers, this will affect patients with cancer, in whom constipation is a common and distressing symptom.
A further risk is that poorer patients, who are less able to pay for their own drugs, will suffer disproportionately from these restrictions, thereby exacerbating health and social inequalities.
Legal case argues cuts to personal budget breach Care Act 2014 Extracts from Canary 17.8.17 https://www.thecanary.co/2017/08/17/chaos-court-david-camerons-former-tory-council-accused-breaking-law-video/
” There were chaotic scenes on Thursday 17 August as Oxfordshire County Council, the borough in which David Cameron’s former constituency sits, appeared in a central London court. It was there to defend itself in a case which is a legal first. And the case the Tory-run authority had to answer? That it’s austerity-driven cuts to vital services may have broken the law.
The Court of Appeal was hearing the case of Luke Davey. In November, a judge granted the 40-year-old from Oxfordshire a judicial review against the council, following a 42% cut to the amount he received to pay for his care and support. This is because Davey has quadriplegic cerebral palsy, is registered blind, and requires assistance with all of his intimate personal care needs. But Davey’s case is a legal first, because his lawyers are using the Care Act 2014 to argue that the council has broken the law. Specifically, that Oxfordshire County Council has breached its obligations under the “wellbeing” principle of the act.
Disabled people’s organisation Inclusion London and campaign group Disabled People Against Cuts (DPAC) are supporting Davey’s case. The groups had organised representatives to support Davey before and during the hearing. And in another legal first, Inclusion London was granted an intervention in the case by the judge: the first time an organisation led by disabled people has been given this privilege ….
Davey’s case, if successful, could set a precedent, as it’s the first time the Care Act 2014 has been cited in law. The council argues that there were two underlying reasons given for its decision to reduce Davey’s personal budget. Specifically, that:
He could spend more time alone without the benefit of a Personal Assistant being present.
Davey could and should reduce the amount which he pays to his Personal Assistants.
But his solicitors say that, by cutting his support from £1,651 a week in 2015 to £950 a week now, Oxfordshire County Council has breached Davey’s rights under the wellbeing principle of the act. Specifically, that it will cause/pose:
Additional and excessive anxiety to Davey, from having to spend unwanted time alone.
The risk of Davey losing his established care team of 18 years.
The wellbeing principle of the Care Act says that a council has a legal duty to “promote” a person’s wellbeing. Specifically:
Personal dignity.
Physical and mental health and emotional well-being.
Protection from abuse and neglect.
Control by the individual over day-to-day life.
Participation in work, education, training or recreation.
Social and economic well-being.
Domestic, family and personal relationships.
Suitability of living accommodation.
The individual’s contribution to society.
The judge will not make their decision immediately. But if the court finds Oxfordshire County Council has breached the wellbeing principle, then it must review Davey’s support package. And aside from that, the case could set a precedent for other people to bring judicial reviews against local authorities.
This is because, as The Canary previously reported, in London alone some councils have cut people’s support by up to 68% since 2015; meaning Davey’s case could open the floodgates for people wanting judicial reviews. And at a time when central government is still cutting welfare, this single case could lead to many more councils ending up in the dock over their abandonment of disabled people”.
Rise in life expectancy has stalled since 2010, research shows Denis Campbell, Guardian 18.7Sir Michael Marmot, a former government adviser, highlights ‘miserly’ levels of spending on health and social care.
A century -long rise in life expectancy has stalled since 2010 when austerity brought about deep cuts in NHS and social care spending, according to research by a former government adviser on the links between poverty and ill-health.
Life expectancy at birth had been going up so fast that women were gaining an extra year of life every five years and men an additional 12 months every three-and-a-half years. But those trends have almost halved since ministers made a “political decision” in 2010 to reduce the amount of money it put into the public sector, said Sir Michael Marmot. The upward trend in longer life that began in Britain just after the first world war has slowed so dramatically that women now only gain an extra year after a decade while for men the same gain now takes six years to arrive. The rate of increase was “pretty close to having ground to a halt”, Marmot said. “I am deeply concerned with the levelling off; I expected it to just keep getting better. Since 2009-2015 it’s pretty flat, whereas we are used to it getting better and better all the time,” added Marmot, who published a major review of health inequalities for Gordon Brown’s Labour government in early 2010.
In 1919 men lived for an average of 52.5 years and women for 56.1 years. That rose to 64.1 years and 68.7 years respectively by 1946. Life expectancy then rose in an almost unbroken gradual upward curve to 77.1 years for men and 81.4 years for women in 2005 and again to 78.7 and 82.6 in 2010, the year David Cameron’s Conservative-Liberal Democrat coalition took office. Since then life expectancy has continued to creep upwards, but at a slower rate, according to Marmot’s latest analysis. In 2015 average life expectancy in Britain was 79.6 years for men and 83.1 years for women, according to the latest Office for National Statistics data.
Marmot, who is the director of the Institute of Health Equity at University College London, denied the rise had stalled because there was a natural limit to how much life expectancy can increase. “It is not inevitable that it should have levelled off,” he said. There is no reason why the UK could not emulate Hong Kong, where life expectancy for men is 81.1 years for men and 87.3 for women – the highest in the world – Marmot added. Hong Kong has overtaken Japan in terms of how long citizens can expect to live.
Marmot, who has also advised the World Health Organisation, did not claim that the introduction of austerity had led directly to life expectancy stagnating. But he highlighted that “miserly” levels of spending on health and social care in recent years – at a time of rising health need linked to the ageing population – had affected the amount and quality of care older people receive.
The long-term trend for NHS budget increases is 3.8% a year, with rises of 1.1% a year since 2010. “If we don’t spend appropriately on social care, if we don’t spend appropriately on health care, the quality of life will get worse for older people and maybe the length of life, too,” he added.
Marmot cited the growing numbers of deaths among the over-75s and over-85s and continuing high death rates from heart disease as other key potential factors in the stalling rise in life expectancy.
“Life expectancy has been increasing year on year for a generation, to the extent that we had begun to take it for granted as inevitable. But this authoritative analysis suggests this long period of improvement may now be coming to an end, with big implications for us all,” said a spokesman for the charity Age UK.
Cases of dementia and Alzheimer’s have been rising so rapidly that they are now the leading cause of death for both sexes, among women 80 and over and men 85+. The increase in dementia and needs of the ageing population will place the NHS and social care services “under considerable strain” in the near future, Marmot added.
The Department of Health played down Marmot’s findings. A spokesman pointed out that the NHS had just last week been judged to be the best, safest and most affordable healthcare system out of 11 rich countries analysed in a major review published by the Commonwealth Fund, a respected US thinktank.
“Life expectancy continues to increase, with cancer survival rates at a record high whilst smoking rates are at an all-time low. We continue to invest to ensure our ageing population is well cared-for, with £6bn extra going into the NHS [in England] over the last two years and an additional £2bn for the social care system,” he added. See podcast at: http://bmj.co/life_expectancy_2017 ( 30 mins)
Staff shortages
NHS maternity wards in England forced to close 382 times last year Guardian 8.8.17
Maternity wards in England were forced to close their doors 382 times in 2016, according to new figures that have triggered claims of women being “pushed from pillar to post in the throes of labour ”. Campaigners warned that expectant mothers could be left in fear of giving birth at the roadside after a wide-reaching freedom of information request found a 70% increase in the number of maternity ward closures over two years.
Research by the Labour party found that 42 hospital trusts had been forced to shut their doors at some point over the last year – 44% of those who responded – with many blaming staff shortages and bed and cot capacity. Fourteen of them admitted they had shut down more than 10 times, with some taking more than 24 hours to reopen. In total, there were 382 occasions when units had to close in 2016. This figure is slightly higher than the 375 occasions from the year before, and an almost 70% increase on the 225 in 2014.
The findings triggered an immediate response from campaign groups, who pointed to the government’s own maternity policy, which says there should be enough midwives to prevent this happening.
Elizabeth Duff, senior policy adviser at NCT, the UK’s largest charity for parents, warned that a single closure at short notice could result in a woman in advanced labour being told to travel miles to another hospital, “leaving them anxious and frightened about having their baby in a car or by the roadside”.
The shadow health secretary, Jonathan Ashworth, described it as “staggering that almost half” of all units had closed down at some point. “These findings show the devastating impact that Tory underfunding is having for mothers and children across the country … The uncertainty for so many women just when they need the NHS most is unthinkable,” he said. “Under this government, maternity units are understaffed and under pressure. It’s shameful that pregnant women are being turned away due to staff shortages, and shortages of beds and cots in maternity units.”
The FoI request – covering data from 2014, 2015 and 2016 – received responses from 96 out of 136 NHS trusts. Trusts reporting maternity closures cited bed capacity problems and high activity. St Helens and Knowsley teaching hospitals NHS trust closed down for more than 30 hours during one period; Bradford teaching hospitals NHS foundation trust shut 10 times; the maternity unit at Royal Berkshire NHS foundation trust had to close 30 times due to “insufficient midwifery staffing for workload”; Mid Yorkshire Hospitals NHS trust said the need to “maintain safety and staffing levels” forced it to close five times, including once for 14.5 hours. Other trusts cited a lack of cots.
Labour highlighted a warning from the Royal College of Midwives earlier this year that maternity services were “reaching crisis point” due to a shortage of 3,500 midwives. The college also warned that more than a third of the NHS’s midwives were nearing retirement age.
Almost all large NHS trusts fail to have correct number of nurses
The Royal College of Nursing says there are 40,000 vacancies in the NHS which is leading to widespread shortfalls in appropriate staffing levels. Paul Gallagher in Indi News August 13th 2017
More than nine in 10 of England’s 50 largest NHS hospital trusts are not staffed with nurses to the level planned by their own management, according to analysis by the Royal College of Nursing (RCN). The findings confirm that hospitals are putting more unregistered support staff on shift to cope with the shortage of registered nurses.
Data released by the NHS shows that substitution is particularly prevalent on night shifts when two-thirds of the largest hospital trusts put more healthcare assistants on the wards than planned. The RCN said the practice raises questions about mortality rates: when the number of fully trained and registered nurses is reduced and the number of unskilled is increased, mortality rates rise significantly.
Since 2014, all hospitals in England have released information on their nurse staffing levels on the NHS Choices website. Some 91 per cent of the 50 largest trusts in England failed to have the number of registered nurses they had planned to have on wards, during the day, on 150 individual hospital sites. More than half of the largest hospitals (55 per cent) brought more unregistered support staff onto the shifts. The over-reliance on unregistered support staff is worse at night, with two thirds (67 per cent) of hospitals increasing numbers on night shifts compared to what they planned due to the registered nurse shortage.
The RCN said the data supports its recent research highlighting 40,000 nurse vacancies across the NHS in England. Janet Davies, RCN chief executive called the figures “startling”. She said: “Patients can pay the very highest price when the Government encourages ‘nursing on the cheap’. It is unfair on the healthcare assistant too – they should not be left in a situation they have not been trained to handle. “Nurses have degrees and expert training and, to be blunt, the evidence shows patients stand a better chance of survival and recovery when there are more of them on the ward.”
Read more at: https://inews.co.uk/essentials/news/health/nurses-vacancies-nhs-trusts-staff-levels/
Is it possible to recruit 21 000 extra staff for mental health services?
Targets for boosting NHS staff seem to trip off the health secretary’s tongue, but what does the reality look like? Gareth Iacobucci reports in the BMJ 15.8.17
The government’s ambitious target to create 21 000 new mental health posts in England by 2020-21 has been welcomed by the NHS, but there are questions as to how it will be achieved.
The £1.3bn (€1.4bn; $1.7bn) pledge to deliver targets set in NHS England’s Five Year Forward View for Mental Health
‘Talk NHS’: Professor Stephen Hawking demolishes Jeremy Hunt over the ‘weekend effect’, and highlights the NHS trajectory towards a US-style insurance system.
On Saturday 19th September 2017 the Royal Society of Medicine hosted a meeting “on the past, present and future of the NHS” under its public engagement programme, in conjunction with ‘Discourse’, a body organising public debates on key political issues “seeking to widen perspectives through increasing participation . . . . by bringing major thinkers and doers together for open discussion”. The debate was billed as a forum for “discussing the circumstances and decisions that have led to the current state of the NHS, and what action is needed to ensure that the NHS sustains its founding principles in and beyond its 70th year”.
A wide range of speakers from different disciplines were invited, including social work, doctor in training, Patients Association, conservative MP, Royal College of Nursing, legal experts, Nuffield Trust, General Practitioner, political Economist, and the President of the Royal College of Paediatrics and Child Health; the audience provided lively questions and commentary.
Speakers recognised that the important fundamental principles of the NHS were under huge pressure from rising demand, workforce deficiencies, and underfunding. The importance of integrating health and social care was emphasised, with the role of social work including a focus on the needs and rights of citizens at a time when austerity was undermining social justice and half a million fewer people were able to access adult social care than just a few years ago. Although the NHS is staffed by dedicated and compassionate workers, the current requirement to deliver £22bn in savings is making it impossible for them to deliver a quality service. With 6,000 too few doctors and 40,000 nurse vacancies in England, staff are increasingly demoralised by being unable to deliver the quality of care to which they aspire, a situation exacerbated by a government in a state of denial.
Sarah Wollaston insisted that Simon Stevens is keen to move away from the internal market, and would like to end wasteful contracting rounds in favour of area based commissioning. However, she did not believe that we were moving to an insurance based system, but were in fact retreating from privatised care. Other speakers and members of the audience were quick to point out that statistics show the precise opposite, with increasing involvement in the NHS of private companies, and new contracts for Accountable Care Organisations clearly expected to attract large international private providers. Louise Irvine, Chair of Health Campaigns Together, pointed out that the government was not seeking to repeal the Health and Social Care Act with its mandate for competition actively encouraging further privatisation.
Tony O’Sullivan, co-chair of Keep Our NHS Public commented that there would be £40 bn extra a year for health care if we spent as much as some other European countries, and that the 30,000 excess deaths highlighted in a recent study from Oxford was an outcome measure of the effects of austerity in the UK. In contrast, the US Commonwealth Fund report (although favourable to the NHS) was based on a survey of opinions, and actually indicated that death and morbidity outcomes for the NHS are relatively poor. It was therefore unaccceptable for Jeremy Hunt to seize on this report as evidence that his leadership has made the NHS the best health care system in the world. Wendy Savage (President of KONP) added that Oliver Letwin and John Redwood articulated the Tory party position on the NHS as far back as 1988 by enthusiastically promoting privatisation and an insurance based system, a philosophy subsequently echoed by Jeremy Hunt.
Claire Gerada castigated those who had not stood up against the Health and social Care Bill, including the Royal Colleges and those in the medical profession who, out of fear or ignorance, had colluded with politicians in the naïve belief that those in positions of authority must be right. Richard Murphy, a political economist, said that the NHS was a practical manifestation of our inbuilt empathy and the fruit of a post-war political will to utilise Keynsian economics in the transformation of society by spending. The neoliberal philosophy that markets are always the right mechanism for distributing resources is a core philosophy of the Tory party, and some other parties, and since 1980 achieved dominance in the NHS. Neoliberals characteristically work by subterfuge, for example promising that they will not reorganise the NHS and then doing the opposite. There is no economic reason for austerity, since the government can print money without limit and claim it back by taxation. Shrinking the size of the state is a key neoliberal principle; organisations are then set up to fail as this is fundamentally necessary to operating a market. The NHS we have is the result of political choice, and a publicly funded NHS is counter to market interests and hence the target of neoliberals.
The keynote speaker of the day was Professor Stephen Hawking. His speech had already been publicised and drawn savage criticism from Jeremy Hunt who urged Professor Hawking to “examine the evidence” and desist from spreading “pernicious falsehoods”. Professor Hawking gave a moving presentation in defence of the NHS, outlining his personal experience of care and his interest beyond this in protecting a service that represented a civilised society. He reflected that his survival in the face of serious illness would not have been possible if it were not for the NHS. In fact, his medical care, personal life and scientific lives had become very much intertwined, so that the question ‘what needs to be done to protect the NHS?’ was one of great importance to him.
Professor Hawking took issue with Jeremy Hunt over seven day working while conceding that this might be of benefit to patients. He went on to emphasise that policy making should be based on evidence, so that “any change like this must be properly researched. Its benefits over the current system must be argued for, and evidence for them presented; and the implementation must be properly planned and costed and the necessary resources provided . . . Hunt has cherry picked research. Speaking as a scientist, cherry picking research is unacceptable. Citing some studies and suppressing others to justify policies that they want to implement for other reasons debases scientific culture.”
He also raised concerns about increasing privatisation, stating: “When politicians and private healthcare lobbyists claim that we cannot afford the NHS, this is the exact inversion of the truth. We cannot afford not to have the NHS. A publicly provided, publicly run system is the most efficient and therefore more cost effective way to provide good healthcare to all.”
In considering what might be done about the present state of affairs, Professor Hawking said that the direction of travel will depend on the relative strength of different forces acting in pursuit of conflicting interests. The multinational companies are driven by profit motive, and the direction of travel currently in the UK is towards a US type insurance system as the balance of power now lies with private companies. On other side is the force of public opinion and democracy, with polls showing that the public agree with his concerns and continue to support the core principles of NHS. This provides hope for the future.
Proposed Contemporary Motion for Labour Party Conference
Conference notes:
• The NHS Accountable Care System (ACS) contracts announced on 7 August impose a basis for 44+ local health services to replace England’s NHS, bypassing Parliamentary debate and legislative process.
• On 9 August, the House of Commons Library revealed a doubling of the number of NHS sites proposed for sale. 117 of these currently provide clinical services.
Like their US templates, ACSs will provide limited services on restricted budgets, replacing NHS hospitals with deskilled community units.
This will worsen health indicators like the long term increase in life expectancy, stalled since 2010.
The ACSs and asset sell-off result directly from the 5 Year Forward View (5YFV) currently being implemented via ‘Sustainability and Transformation Partnerships’ (STPs). The 5YFV precisely reflects healthcare multinationals’ global policy aims.
Conference reaffirms its manifesto commitment to restore our NHS by reversing its privatisation and halting STPs. We therefore call on the Party to oppose and reverse funding cuts (ideally meeting Western European levels) but also 5YFV policy:
• creating ACSs;
• replacing 7500 GP surgeries with 1500 “superhubs”;
• downskilling clinical staff.
• reclassifying NHS services as means-tested “social care”;
• cementing the private sector role as ACS “partners” and as combined health/social care service providers.
Conference recognises that reversing this process demands more than amending the 2012 Health & Social Care Act and calls for our next manifesto to include existing Party policy to restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17).
2nd September – Kirkstall Abbey Museum’s little exhibition on local protest opens. Dr Puntis giving the first talk at 2.30 on Tuesday 12th September
13th September, 2-3.30pm, Albert Room, Leeds Town Hall – meeting of the new combined Leeds CCGs.
16th September 11am – Leeds KONP stall outside Boots, Commercial St
27th September. 2.30pm, Gledhow Seminar Room, Gledhow Wing, St James – Leeds Teaching Hospitals Trust AGM
28th September, 9.30am, Rosebowl – Leeds Health and Wellbeing Board, 10 mins at the beginning is reserved for questions from the public
October…
October 1st, Tory Party Conference Protest Assemble 12 noon at Castefield Arena, Rice St. Manchester, M34JR
28th October, Barnsley – Yorkshire Health Campaigns Together will be supporting a south Yorkshire demonstration on cuts, closures, the newly imposed Accountable Care System.
- Protest / KONP exhibition opens at Kirkstall Museum : Sunday August 6th meet 2pm by the museum steps
- Yorkshire Health Campaigns Together Meeting : Sat 2nd September
- Leeds KONP stall :
- 15th Sept 1.30 -3.30,
- Sat 16th 11am near Boots
- Leeds Teaching Hospital Trusts Board Meeting: Wed. 27.9 2.30 at St. James
- Health and Wellbeing Board : Thurs. 28.9 at 9.30
Latest minutes:
Just as in 2014, our NHS again is no 1 in the world for healthcare. Health leaders need to listen and learn that privatisation of healthcare leads to an ongoing series of expensive, unnecessary failures that damage patients, damage staff, damage the economy and lead to loss of life.
Take Action Now!
• Urge your MP to oppose cuts, press the Government to fund the NHS to provide top quality care and support the NHS Reinstatement Bill. This will scrap the 2012 Health & Social Care Act and restore a publicly funded, publicly provided and accountable National Health Service
• Resist plans for £22 billion more NHS cuts to services across Yorkshire.
• Stop contracting out NHS employees.
• Stop the sell-off of NHS Land and Assets
• Support fair pay for NHS staff and the re-instatement of the bursary for nurses and other key health workers.
